Manager, HEDIS Operations

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

Alignment Healthcare is a data and technology driven healthcare company focused on partnering with health systems, health plans and provider groups to provide care delivery that is preventive, convenient, coordinated, and that results in improved clinical outcomes for seniors.

We are experiencing rapid growth (backed by top private equity firms), our Data Services and BI team is looking for the best and brightest Manager HEDIS Operations. Data drives the way we make decisions. We love our customers and understanding them better makes it possible to provide the best clinical outcome and care experience.

This position will play a key role in design and development of cloud-based BI and Analytics services using Microsoft BI Platform, Microsoft Azure cloud services.

Alignment Healthcare was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care to one person at a time.

By becoming a part of the Alignment Healthcare team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment community.

Position Summary:

Alignment Healthcare is a data and technology driven healthcare company focused on partnering with health systems, health plans and provider groups to provide care delivery that is preventive, convenient, coordinated, and that results in improved clinical outcomes for seniors.

We are experiencing rapid growth (backed by top private equity firms), our Data Services and BI team is looking for the best and brightest Manager HEDIS Operations. Data drives the way we make decisions. We love our customers and understanding them better makes it possible to provide the best clinical outcome and care experience.

This position will play a key role in design and development of cloud-based BI and Analytics services using Microsoft BI Platform, Microsoft Azure cloud services.

General Duties/Responsibilities (May include but are not limited to):

• Translate business requirements into specifications that will be used to implement the required reports and dashboards.
• Design and publish custom dashboards for business functions, stakeholders, and corporate users around the company.
• Design, model, develop & optimize stored procedures to meet data management and data reporting objectives.
• Support accurate HEDIS data collection (Claims and administrative data, medical record reviews, CAHPS Surveys ) data abstraction, and reporting.
• Interpret and apply NCQA HEDIS technical specifications and measurement requirements.
• Monitor, track, analyze, and report HEDIS performance metrics.
• Develop, maintain and improve operational HEDIS /STAR workflows and processes.
• Manage data quality, validate measure logic, and prepare metrics for reporting and audits.
• Coordinate end-to-end HEDIS processes, including chart chase/abstraction and vendor management
• Partner with clinical and operational teams, vendors, and systems to ensure data integrity and completeness.
• Track performance trends and identify opportunities for compliance improvement measures.
• Support HEDIS audit activities end-to-end including proper documentation and artifacts.
• Create functional and technical design documents and maintain documentation for all reports and dashboards created or modified.

Minimum Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.The requirements listed below are representative of the knowledge, skill, and/or ability required.Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

• Minimum Experience:
  • 6+ years of business intelligence & reporting experience.
  • 6+ years of experience with BI/Reporting software products (MSBI) and knowledge of Healthcare Industry standards and requirements.
  • 6+ years’ experience and Strong data interpretation and analytic skills
  • 3 + Years of HEDIS /STAR Workflow/process development
  • Strong SQL skills with Power BI and SSRS (Paginated Report) experience
  • Knowledge of different file formats (Standard and Non-Standard) such as EDI, HL7 and custom files
  • Extensive hands-on experience with Microsoft’s Power-BI/SSRS/SSAS/Azure Data Factory and other cloud based BI and Reporting services.
  • Experiences on Big data /Azure Data Platform is a plus.
  • Experience with Azure, AWS or GCP is a plus.
• Education/Licensure:
  • BS in Computer Science, IT or equivalent and/or equivalent experience.
  • Microsoft Azure Certification is a plus.
• Other:
  • Improve team workflows, establish sound development practices, and monitor project progress through agile stand-ups and planning sessions.
  • Maintain documentation and team standards for tools and processes.
  • Strategic and analytical thinking to translate data into insights
  • Strong organizational and project management skills are supported by data governance and quality best practices.
• Work Environment
  • The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is regularly required to talk or listen. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
• The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.

If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact careers@ahcusa.com.

Pay Range: $126,422.00 - $189,634.00

Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email careers@ahcusa.com.